As CDC director Thomas Frieden said at one point, it was inevitable that Ebola would reach the U.S. Now that it has, the CDC expresses confidence that it will be easily contained, but the Association of American Physicians and Surgeons (AAPS) warns against complacency.
The Dallas patient presented to the emergency room at a prominent hospital several days before admission, and was sent home, AAPS notes, despite the fact that he arrived by air from a country suffering a raging epidemic.
An advisory from the Arizona Health Alert Network that relates to this case states: “As transmission only occurs through direct contact with blood or body fluids of ill or deceased individuals, the risk of ongoing transmission is very low with appropriate control measures.”
“How can we be sure of this without knowing how every Ebola patient got infected?” asked AAPS Executive Director Jane M. Orient, M.D. “Other viral illnesses can be transmitted by patients who do not appear to be ill. Moreover, one can come in contact with body fluids without directly touching the patient.” She cited concerns of workers about handling linens and contaminated waste from a previous patient treated in Atlanta.
The Dallas patient was ill and hence infectious during his first emergency department visit and during the time between discharge and return, Dr. Orient noted. Were “appropriate measures” taken to protect emergency department staff (including housekeeping), other patients, and out-of-hospital contacts? The number of potential contacts could be very large.
“A travel and exposure history needs to be obtained for all patients with fever, headache, muscle pain, or other symptoms that could be Ebola,” she advised. At present, Ebola screening tests are probably obtainable only from the public health department. Hospitals need to assess the availability of adequate protective gear, safe laboratory testing, intravenous fluids, infectious waste disposal, and isolation rooms. All personnel need to be informed of the risk.
“We should be taking aggressive measures to stop this disease now,” Dr. Orient stated, “instead of congratulating ourselves on our sophisticated system.” She added that we need screening at points of entry, not an open “air bridge” for deadly diseases.
“Above all, our public health authorities must provide an honest assessment of the threat and the unknowns, rather than blanket assurances that we are safe.”
The Association of American Physicians and Surgeons (AAPS) is a national organization representing physicians in all specialties, founded in 1943 to preserve private medicine and the patient-physician relationship.